Association Between Sensorineural Hearing Loss and Neurocognitive Performance in Survivors of Childhood Cancer: A Systematic Review and Meta-Analysis.
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BACKGROUND: Various studies have shown that sensorineural hearing loss (SNHL) is associated with neurocognitive impairment among childhood cancer survivors, though prior studies are limited by small sample sizes and inconsistent methods. OBJECTIVE: This systematic review and meta-analysis aimed to quantify neurocognitive differences between survivors with severe SNHL (s-SNHL) and those without. METHODS: Studies were included if they evaluated childhood cancer survivors (diagnosed ≤ 21 years), were ≥ 2 years posttreatment, received cranial radiation and/or platinum-based chemotherapy, used validated neurocognitive tests, and included survivors with and without SNHL. Methods and reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched included PubMed, Web of Science, Cochrane, Scopus, PsycINFO, and Embase. Study quality was assessed using an adapted version of the Newcastle-Ottawa Scale. We collected study details, including authors, year, neurocognitive tests used, sample sizes, and group scores (means and standard deviations [SD]). Pooled mean differences (MD) and 95% confidence intervals (95% CI) were calculated using standard scores (mean = 100, SD = 15) and random-effects models. RESULTS: Of 1012 records identified, nine studies were included in the analyses, with 503 childhood cancer survivors with s-SNHL and 1553 survivors without s-SNHL. Compared to survivors without s-SNHL, survivors with s-SNHL scored lower on measures of overall intellectual functioning (MD = -8.1, 95% CI = -10.0, -6.2), verbal reasoning (MD = -9.7, 95% CI = -11.4, -7.9), perceptual reasoning (MD = -6.6, 95% CI = -11.1, -2.1), working memory (MD = -5.3, 95% CI = -7.1, -3.4), processing speed (MD = -6.3, 95% CI = -9.9, -2.6), short-term visual memory (MD = -6.0, 95% CI = -8.2, -3.7), and reading (MD = -6.2, 95% CI = -7.9, -4.5). CONCLUSIONS: Severe SNHL is associated with significant neurocognitive deficits in childhood cancer survivors. Routine hearing screening and timely neurocognitive assessments are recommended to identify and address these impairments. TRIAL REGISTRATION: PROSPERO: CRD42023440952.